A comparative study of non-operative and operative management in fracture clavicle

Abstract

The clavicle fractures managed non-operatively have shown a high prevalence of symptomatic malunion and non-union. We sought to compare patient-oriented outcome and complication rates following non-operative treatment and those after operative treatment of clavicular fractures. In a prospective randomised study, 30 patients with 30 clavicle fractures were randomised by systemic allocation to either operative treatment or non-operative treatment. Fifteen patients were in each group. Outcome analysis included standard clinical follow-up and the disability of the arm, shoulder and hand (DASH) score, and plain radiographs. The mean follow-up of both groups were 12.56 months. DASH scores were significantly improved in the operative fixation group at all time-points. The mean time to radiographic union was 27.46 weeks in the non-operative group compared with 15.73 weeks in the operative group (p = 0.000). There were no non-unions in both groups. Symptomatic malunion developed in seven patients (46.66%) in the non-operative group and in none in the operative group. The complications in the operative group were hardware-irritation (one case) and incisional numbness (one case). At final follow-up, the patients in the operative group were more satisfied with the appearance of the shoulder (p = 0.039) and with the shoulder in general than were those in the non-operative group. There were no differences between the two groups with respect to patient age, sex, side of injury or associated injuries. Operative fixation of AO type B2 clavicular fracture results in improved functional outcome and early union compared with non-operative treatment at one year of follow-up. This study supports primary operative fixation of completely displaced mid shaft clavicular fractures in active adult patients.